UNIONBANK GSIS ECARQ-CUSTOMER INFORMATION RECORD AR NOMBER T ACCOUNT WONBER | : o— som k ‘ON CARD, v ‘NAME premicns to Fe ee tereneren . " OF BIRTH > | TELEPHONE NUMBER: wo ‘NUMBER, sis Nuveen THER WAIDEN NAME | ewan Aooness -——--______ SPECIMEN SIGNATURE fee i SIGNATURE Dae ™ 'GENTIFIED ANO SIGNATURE VERIFIED BY/DATE | CARO ANO PIN MAWLER RELEASED BYU we PRESENTE = SIGNATURE UPDATE FORM GSIS ECARD REPLACEMENT tease atic your now full algnature using black ink inside each box.SPECIAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: r _, of legal age, Filipino and with residence address at , hereby appoint ————Tilipine, of legal age, single/married, with Yesidence at, , to be my true and lawful Attorney-in-Fact, for me, and in my name, place and stead, to do and perform the following acts and things, namely: a) To withdraw and receive proceeds of withdrawals from my GSIS Savings Account No__ at Unionbank of the Phils. b) To sign, execute and deliver any and all documents and instruments that may be required by the Bank in connections with or in any way arising from the foregoing authorizations granted by the undersigned under this Special Power of Attorney to Attorney-in-Fact, including the authority to hold the Bank free and harmless against any claims and losses that may arise in furtherance of the terms of this Special Power of Attorney. HEREBY GIVING AND GRANTING TO my said Attorney-in-Fact full power and authority to do and perform every act and thing requisite and necessary to be done in and above the premises, hereby ratifying and confirming all that my said Attorney-in-Fact may do or lawfully cause to be done by virtue of these presents. THIS POWER OF ATTORNEY shall expire after a period not exceeding (6) months from the date of execution hereof. IN WITNESS WHEREOF, I have hereunto affixed my signature this day of ‘ Accepted: principal/Pensioner Attorney-in-fact SIGNED IN THE PRESENCE OF: ACKNOWLEGMENT REPUBLIC OF THE PHILIPPINES) ) BEFORE ME, a Notary Public for Zamboanga City, personally appeared > with Community Tax Cert. No. Tssued = at dated ; known to me and to me Gown to be the same person who executed the foregoing Special Power of Mrterney and acknowledged to me that the same is his free and voluntary act and deed. Doc. No. page No. Book No. _ series of ___* Z NOTARY PUBLIC